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Saturday, 19 January 2013

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"knowledge of mental disorder is still in its infancy": it may be worse that that, Duffers. It may be that ignorance is nearly complete and that the fashion of how to treat madmen just goes in cycles.

Probably the most sensible line to take in such matters is to avoid taking sides, so to speak. We feel ourselves wanting to "sort out" these disturbed individuals; and then we feel ourselves revolted by the treatment they receive when someone else is paid to sort them out; and then we realise that the medics are only doing their best under very difficult circumstances; etc. Our mind oscillates back and forth because it is too painful.

Well done to you for recognising this, and not rushing to easy judgements.

Even defining what constitutes a 'madman' is hideously difficult, DM.

I suppose, 'W', that the only definite thing is that those likely to harm others (not easy to judge with exactitude) must be locked up and medicated; and those likely to harm themselves must be helped in whatever way seems appropriate. I just wish -and hope - that those with the responsibility act with due care and intelligence. Well, one can hope!

Just an observation from someone, who although it is not my speciality, has some experience of the area, as well as over-lap of treating people with mental health issues.

Perspective, as in all things, is everything.

The imagery of "six beefy men" is almost frightening and yet.. seven is mandated by law and health and safety, to protect the person being restrained (one each for legs, arms, torso and to stabilise and protect the head, with one standing observing, controlling to ensure no injury). Then again, as a 6' 5" male, 'beefy' male mental health nurses appear, from twenty-mumble years experience, rather thin on the ground (whilst males are a greater percentage in mental health nursing than any other area the vast majority of staff remain the average small female). Then again the description is, understandably, reticent about just what Michaels behaviour without neuroleptics was like (most patients injuries in secure units are, not surprisingly, received from other patients), would her view have been different if subjected to such an attack, probably but irrelevant.

The protections against wrongful confinement and treatment against a persons wishes are so numerous and byzantine to almost make it impossible, and yet.. with some the hoops have to be jumped through (not only to prevent them from harming others but themselves as well, more often in fact). As an aside, its not just in mental health circles this issue exists - try contracting Tuberculosis (open pulmonary) and refusing treatment to see what I mean.

I, personally, think that the balance (almost entirely in favour of patients rights) is correct (with multiple independent professionals needed to institute a 'Section', constant reviews, independent and adversarial advocates present throughout,...). My one issue is that with the closure of the large institutions (in common with general medicine for that matter) the majority, who enter voluntarily in times of need, are left without support.

The motivation may have been 'moral' and the impetus 'financial' but the results have neither been moral (destitute victims, deaths, injuries and suffering) or any financial saving (the higher costs of 'care in the community' - but that's OK as it's 'someone elses budget').

I just don't know!

Someone I know runs an old folks home. In selecting staff she has to choose people who are suited to the work - day after day, year after year. She has developed a feel for the kind of people who fit the work but then has to choose from those who will work for the wages/conditions etc. Not an easy balance at all - small wonder less fussy or more pressured establishments end up with trouble.

Able, you describe exactly why it is so difficult for outsiders to make judgments in an area fraught with difficulties. By and large, if someone has a broken leg the treatment is standard and obvious but any attempt to heal a mind - assuming that you are satisfied that it needs 'healing' in the first place - is in difficulty from the off because all minds are individual, formed as they are from a zillion influences beginning with genes and honed by personal experiences. As you know, Able, I never hesitate to put the boot into the worst sort of 'psycho-babblers' but I do have considerable respect for those members of that profession who remain humble as they grope their way to some sort of soundly-based approach to mental ill-health. In the meantime I can only echo your own words - "I just don't know".

Roger, you touch on another important aspect of this problem. The "poor, bloody infantry" of this area of medical treatment should have the temperament of saints to do what they have to do day in, day out. But of course, they are not, they are people - with all that that word entails.

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